PUBLISHED
August 11, 2024

KARACHI:

In the dynamic environments of the emergency department (ED) and personal decision-making, the pursuit of clarity and rationality is often hindered by our own cognitive biases, logical fallacies, and irrational thinking patterns. As I embark on an exploration of ‘thinking how (not) to think’ I am reminded of the deeply human nature of decision-making be it professional or personal. A recent insightful exchange with a colleague underscored the profound influence of stress and emotion on our thought processes. In the high-stakes environment of the ED, where split-second decisions can mean the difference between life and death, understanding this human dimension takes on a heightened significance.

This essay aims to delve deeply into the above and related phenomena, exploring their implications in EDs and how those can be a mirror to navigating complexities of everyday life.

Confirmation bias and ad hominem: unveiling biases

In the ED, imagine a patient presenting symptoms aligned with a specific diagnosis. Despite contradictory evidence, medical professionals might interpret subsequent findings to confirm their initial suspicion, falling victim to confirmation bias. Similarly, individuals in personal life may dismiss differing perspectives that challenge their beliefs, seeking out information that reinforces their worldview. Ad hominem reasoning also influences decision-making. It occurs when an argument is rebutted by attacking the person making it rather than the argument itself. For instance, medical professionals might disregard valid insights from a disliked colleague. Similarly, individuals might discount others’ opinions based on unrelated factors like appearance or background. Both confirmation bias and ad hominem reasoning highlight how biases impact decision-making. Addressing these biases is crucial for promoting critical thinking and making well-informed decisions based on evidence and reason.

Post hoc ergo propter hoc and non sequitur: deciphering causality

In professional medical practice and personal realms, flawed causal reasoning often occurs through post hoc ergo propter hoc and non sequitur fallacies. Post hoc ergo propter hoc, Latin for “after this, therefore because of this,” wrongly assumes that if one event precedes another, it caused it. Similarly, non sequitur means “it does not follow,” where conclusions drawn do not logically follow from the premises. For example, in the ED, if a patient improves after receiving a treatment, assuming the treatment caused the improvement without considering other factors is post hoc ergo propter hoc. Likewise, in personal life, assuming that wearing a lucky charm led to success in an unrelated event is a non sequitur fallacy. Recognizing and addressing these misinterpretations is essential. Techniques such as critical evaluation of evidence, considering alternative explanations, and understanding correlation versus causation help individuals navigate the complexities of causality with clarity and precision.

The gambler’s fallacy and the availability heuristic

In the ED, medical professionals may succumb to the Gambler’s Fallacy, mistakenly believing that repeated unsuccessful treatments increase the likelihood of success. This bias stems from the erroneous assumption that past outcomes influence future probabilities, leading to misguided decision-making. Similarly, individuals in personal life may exhibit the Gambler’s Fallacy by overestimating the likelihood of a favorable outcome based on past experiences. For instance, someone experiencing a string of unlucky events might irrationally anticipate a change in luck, influencing their decision-making process. Furthermore, the Availability Heuristic can impact decision-making in both professional and personal contexts. This mental shortcut leads individuals to rely on easily recalled examples when making judgments. In the ED, medical professionals may overestimate the prevalence of certain conditions if recent cases are particularly memorable or salient, thereby biasing their decisions. Similarly, individuals in personal life may make decisions based on vivid, easily recalled examples rather than objective probabilities. For example, someone might perceive a rare event, such as a plane crash, as more likely to occur than statistical probabilities suggest due to its extensive media coverage.

To counteract these biases, individuals must consciously assess decision-making processes, striving to base judgments on objective probabilities and evidence rather than subjective impressions or past experiences. This may involve seeking out additional information, critically evaluating available evidence, and considering a broader range of possibilities before arriving at decisions. By recognizing and mitigating the influence of the Gambler’s Fallacy and the Availability Heuristic, individuals can attain a more balanced perspective and make more rational decisions.

The anchoring effect and sunk cost fallacy

In the ED, the Anchoring Effect can significantly influence decision-making among medical professionals. This cognitive bias occurs when individuals rely too heavily on initial information or impressions, known as “anchors,” when making subsequent judgments. For instance, if a patient’s symptoms initially suggest a particular diagnosis, medical professionals may unconsciously anchor their subsequent assessments and treatment plans around this initial impression, potentially overlooking alternative explanations or evolving symptoms. Consequently, patients may experience delays in receiving appropriate care as medical professionals remain anchored to their initial diagnostic assumptions. Similarly, in personal life, individuals may fall prey to the Sunk Cost Fallacy, wherein they persist in relationships or endeavors long after they have ceased to be viable. This bias arises from the tendency to consider past investments—whether financial, emotional, or temporal—as irrecoverable, leading individuals to continue investing resources in pursuits with diminishing returns. For example, someone in a failing relationship may feel compelled to stay due to the time and effort already invested, even if the relationship no longer brings fulfillment or happiness.

In both professional and personal contexts, the Anchoring Effect and Sunk Cost Fallacy can trap individuals in past decisions, hindering their ability to adapt to changing circumstances or recognize when it is time to cut their losses. To overcome these biases, individuals must consciously reassess their decisions, disentangling themselves from past anchors or investments and objectively evaluating the current situation. By acknowledging the influence of these biases and adopting a forward-thinking mindset, individuals can break free from the constraints of past decisions and make choices that align with their present circumstances and future goals.

The Dunning-Kruger effect and irrational confidence

In the high-stakes environment of emergency medicine, the Dunning-Kruger effect can profoundly impact decision-making among medical professionals. This cognitive bias occurs when individuals with limited knowledge or expertise mistakenly overestimate their abilities, leading to errors in judgment and performance. In the context of emergency medicine, medical professionals may exhibit this bias by inaccurately assessing their competence in diagnosing complex cases or performing intricate procedures. As a result, they may unwittingly make diagnostic errors or choose inappropriate treatment strategies, jeopardizing patient outcomes. Similarly, in personal life, individuals may succumb to the Dunning-Kruger effect by overestimating their competence in various domains, from cooking and driving to interpersonal communication and financial management. This unwarranted confidence can lead to poor decision-making, interpersonal conflicts, and even financial losses. For example, someone with limited knowledge of investing may mistakenly believe they possess superior skills and knowledge, leading them to make risky financial decisions that result in significant losses.

To mitigate the dangers of irrational confidence and cultivate a culture of growth and improvement, both medical professionals and individuals must prioritize humility, self-awareness, and continuous learning. By acknowledging their limitations and embracing opportunities for growth and development, medical professionals can enhance their clinical skills and expertise, ultimately improving patient care and outcomes. Likewise, individuals in personal life can benefit from adopting a humble mindset, recognizing that true competence requires ongoing learning and refinement. Through a commitment to self-improvement and a willingness to seek feedback and guidance, both medical professionals and individuals can overcome the pitfalls of irrational confidence and embrace a path of continuous growth and improvement.

Circular reasoning and confirmation bias

In the fast-paced environment of emergency medicine, circular reasoning and confirmation bias pose significant challenges to sound decision-making among medical professionals. Circular reasoning occurs when individuals support their beliefs or conclusions by restating them in different words, effectively assuming the truth of what they are trying to prove. In the context of emergency medicine, this may manifest when medical professionals rely solely on their initial diagnostic impressions to interpret subsequent findings, failing to consider alternative explanations or contradictory evidence. By uncritically reinforcing their preexisting beliefs, medical professionals risk overlooking important clinical information and making erroneous diagnoses or treatment decisions. Similarly, in personal life, individuals may engage in circular reasoning when justifying their beliefs or behaviors, using circular arguments to reinforce their worldview without critically evaluating contradictory evidence or alternative perspectives. This tendency to rely on self-reinforcing logic can perpetuate cognitive biases and hinder open-mindedness and intellectual growth. Confirmation bias exacerbates these challenges by influencing medical professionals and individuals alike to seek out information that confirms their preexisting beliefs while dismissing or ignoring contradictory evidence. In emergency medicine, confirmation bias may lead medical professionals to selectively interpret diagnostic tests or clinical findings in a way that aligns with their initial suspicions, rather than objectively evaluating all available information.

To navigate these challenges effectively, medical professionals and individuals must cultivate intellectual humility and a willingness to challenge their own assumptions. By actively seeking out diverse perspectives and considering alternative explanations, medical professionals can guard against the pitfalls of circular reasoning and confirmation bias, ultimately improving diagnostic accuracy and patient care. Likewise, individuals in personal life can benefit from adopting a critical mindset, questioning their own beliefs and assumptions and remaining open to new information and perspectives. Through a commitment to intellectual honesty and open-minded inquiry, both medical professionals and individuals can navigate the complexities of decision-making with clarity and discernment.

Cognitive dissonance: harmonizing conflicting beliefs

In the ED, medical professionals often face situations where conflicting diagnostic findings or treatment options create psychological discomfort known as cognitive dissonance. This occurs when individuals hold contradictory beliefs, causing inner tension and discomfort. Similarly, in personal life, people may experience cognitive dissonance when decisions challenge their core values or beliefs, leading to uncertainty and inner conflict.

To address cognitive dissonance, individuals must recognize and acknowledge conflicting beliefs. In the ED, this might involve seeking input from colleagues or consulting ethical guidelines. In personal life, it may mean reflecting on conflicting priorities and considering alternative perspectives. Resolving cognitive dissonance requires achieving coherence and harmony in belief systems, which may involve revisiting and revising deeply held beliefs. By embracing flexibility and adaptability, individuals can navigate cognitive dissonance with resilience, achieving greater clarity and peace of mind.

Additional concepts

Beyond the confines of cognitive biases and logical fallacies, a myriad of irrational thinking patterns influences decision-making in both professional and personal contexts. Let’s explore three additional concepts—Occam’s Razor, Murphy’s Law, and Schrödinger’s Cat—and their relevance to the foregoing thinking patterns.

1. Occam’s Razor: Also known as the principle of parsimony, Occam’s Razor suggests that among competing hypotheses, the one with the fewest assumptions should be selected. This concept emphasizes simplicity and elegance in explanations, guiding us to favor straightforward interpretations over convoluted ones. In the context of cognitive biases and logical fallacies, Occam’s Razor encourages us to question overly complex explanations and instead seek simpler, more plausible solutions. For example, it may prompt medical professionals in the ED to reconsider diagnoses that rely on intricate chains of reasoning and instead opt for diagnoses supported by straightforward evidence.

2. Murphy’s Law: This states that “anything that can go wrong, will go wrong.” While often humorous, this adage underscores the inevitability of setbacks and challenges in both professional and personal endeavors. In the realm of cognitive biases, Murphy’s Law serves as a cautionary reminder of the potential for errors and oversights, prompting us to anticipate and prepare for unexpected outcomes. For instance, it warns medical professionals in the ED to remain vigilant against complacency and to consider worst-case scenarios when making critical decisions.

3. Schrödinger’s Cat: This is a thought experiment in quantum mechanics that illustrates the concept of superposition, wherein a cat inside a sealed box is considered both alive and dead until observed. This paradox challenges our intuitions about reality and highlights the role of observation in shaping outcomes. In the context of cognitive biases, Schrödinger’s Cat prompts us to recognize the influence of perception and interpretation on our understanding of events. For example, it encourages individuals in personal life to question their assumptions and consider alternative perspectives before arriving at conclusions. Similarly, it reminds medical professionals in the ED to approach diagnoses with a willingness to entertain multiple possibilities and to remain open to new information.

By integrating Occam’s Razor, Murphy’s Law, and Schrödinger’s Cat into our understanding of cognitive biases and logical fallacies, we gain a broader perspective on decision-making processes, allowing us to navigate the complexities of both professional practice and personal life with greater wisdom and discernment.

Charting a course for rational decision-making

As my colleague aptly pointed out at the outset, our thinking patterns are not immune to the pressures of stress and the nuances of human interaction. In the ED, where emotions run high and every decision carries immense weight, medical professionals must navigate a complex tapestry of cognitive biases and logical fallacies, hence the importance of ongoing vigilance, education, and training. It is in these moments of intense stress and uncertainty that our humanity shines through, as we strive to make decisions that not only reflect our clinical expertise but also our compassion and empathy for those in need.

By incorporating insights from the ED into everyday life, I chart a course for rational decision-making and personal wellbeing. Through a commitment to evidence-based reasoning, intellectual humility, and a willingness to challenge our own assumptions, we pave the way for a future where clarity of thought and reasoned discourse prevails in both professional practice and personal life.

 

Asad I Mian MD, PhD is an ER physician-researcher-innovator at the Aga Khan University and a freelance writer. He writes on topics ranging from healthcare and education to humor and popular culture. He authored ‘An Itinerant Observer’ (2014) and ‘MEDJACK: the extraordinary journey of an ordinary hack’ (2021)

All information and facts provided are the sole responsibility of the writer

 

PUBLISHED
August 11, 2024

KARACHI:

A chain is said to be as strong as its weakest link and the same can be said about humans and their mental health and resilience, especially in trying times like economic and political crises. Mental health of masses is intricately linked with their environment and the available opportunities of sustenance and growth. In times of sustained turmoil, a sense of helplessness sets in, leading to depression, financial anxiety, future fears, and general decline in people’s daily functioning. This trend tends to exacerbate the economic burden of the countries, especially in developing and low and middle income countries. In Pakistan, a similar state is being observed, especially in the youth. There has been a massive brain-drain in last few years; however, those with less opportunities or possibilities of relocating for better prospects are reportedly experiencing severe hopelessness and a complete sense of powerlessness over their life circumstances.

The question arises, here, is whether there is really no hope. Are we, as humans, really just a product of our environment, or there is a way to, first, survive the situations and, later, to thrive despite the economic and political realities of our country? The answer lies in the “linchpin” that holds it all together for people, their mental health and resilience. People with better mental capital and psychological flexibility tend to prosper more compared to their counterparts. Along with the inherent psychological capital, there are some common strategies that people can utilize to deal with the economic and political uncertainty and perceived defenselessness of the present times.

First and foremost, stay focused on the present. Regrets of past or worries about future hold no value in helping you deal with your current situation. While planning ahead is a good strategy, becoming fixated on it takes the energy and focus away from the issues at hand. Additionally, when thinking about future, people tend to catastrophize and get caught in the downward spiral of “what ifs”. While it is possible that future may hold more hardships, it is equally possible to have brighter times ahead. With no means of glimpsing into the unknown, a smart move is to keep yourself anchored to the present to ensure that more pressing issues do not get ignored, leading to additional mental burden.

Second key factor is staying relaxed. While in may appear counterintuitive, being relaxed helps you access your mental faculties to deal with present situations in an effective manner; it can be achieved by ensuring routine and engagement in daily activities. Helplessness creates psychological stagnation, followed by physical inactivity. This consequently leads to compromised mental health as being physically active is directly linked with positive neural functioning. People can conjure up solutions to even complicated problems, provided they have optimal psychological functioning. Committing to consciously engage in physical activities like walking, or low intensity exercises at home; social activities, like spending quality time with family and friends; spiritual activities, like reflecting upon your thoughts, connecting with your prayers, or serving those less fortunate; and adopting a new hobby can ensure that people are able to deal with adversities effectively. Flexible routines not only give a sense of control in otherwise uncontrollable situations, they also induce relaxation, and physical activity is directly linked with better sleep quality as well.

Another significant component is seeking and providing social support. Social capital sustains individuals; rather than comparing selves to others, leading to shame and social isolation, focus on building relationships. In trying times, relying on trusted others can create a sense of safety, curtailing depression, anxiety, and stress.

A shift in mindset is also an imperative strategy in difficult times. People tend to fixate on uncontrollable factors, leaching their energy. Bringing the focus from uncontrollable to controllable domains of your life can bring a sense of relief and direction. Identify the stressors of your life, differentiate between the controllable and the uncontrollable components, list down the strategies and plan of actions for controllable stressors, and shift your focus away from overwhelming strains that are beyond your area of influence. Rather than ruminating about inflation, and socio-political and economic turmoil of your country, factors well beyond your reach, invest in reading the financial market to increase the possibility of enhancing your financial influx, learn a new skill that is pertinent in contemporary times, and be vigilant about growth opportunities.

An additional important component to deal with the current situation would be to be savvy about your finances. Be aware of your financial outflow; create a revised monthly budget, cut down on avoidable expenses, track your savings if any, and even reach out to a professional financial advisor if needed. These steps may appear overwhelming at a glance; however, once accomplished, they can provide an essential sense of control over your circumstances.

Dr Fareeha Kanwal is a clinical psychologist and freelance contributor

All information and facts provided are the sole responsibility of the writer